Safety Net Provider Participation In Medicare Accountable Care Organizations

• In Event: Policies Affecting Medicare Beneficiaries

Abstract

As key safety net providers, Federally Qualified Health Centers administer care to 30 million underserved, low-income, and traditionally marginalized people per year, 10% of whom are Medicare beneficiaries. However, limitations in the services offered and access to wider provider networks have traditionally hindered FQHC providers’ abilities to ensure patients have access to specialty services. With the focus on reducing uncoordinated care, many Accountable Care Organizations (ACOs) have incorporated FQHCs over the past decade. This new partnership may provide to a larger network for Medicare beneficiaries in underserved areas access to needed services beyond what is offered in Federally Qualified Health Centers. We investigated whether Federally Qualified Health Centers participating in ACOs network improve care integration, reduce disparities, and reduce overall costs among Medicare beneficiaries by providing access to preventive specialty services such as breast cancer screenings within ACO networks. We utilized the universe of Medicare fee-for-service outpatient claims between 2014 and 2022 to identify Medicare beneficiaries receiving primary care from FQHCs and identified whether these beneficiaries received breast cancer screenings according to United States Preventive Services Task Force (USPTF) guidelines. We further identified whether the FQHCs in which beneficiaries received care were associated with an ACO. Although nearly 1 in 3 FQHCs participate in ACOs and nearly 1 in 3 ACOs count an Federally Qualified Health Centers as a participant, our preliminary results suggest this partnership has not resulted in increased access to preventive specialty care. Using a two-way fixed effects design and controlling for beneficiary ACO assignment, we found a 1.5 percentage point decline in breast cancer screening rates among Federally Qualified Health Centerss after joining an ACO. These preliminary results raise questions about the role FQHCs may play in the overall care of Medicare beneficiaries assigned to ACOs and whether participating in ACOs increases Federally Qualified Health Centers access to specialty care for all beneficiaries.

Author

• Salama S Freed, George Washington University
  Presenting Author